The problems associated with narcotic abuse and addiction and of the seemingly ubiquitous narcotics addict are very well known in today's society. Also well-known are the problems associated with curing an addict of his drug dependence. Because very often there is a psychological as well as a physiological dependence, the addict, once he has been withdrawn (cured) from his physiological drug dependence, will often return to narcotic usage for other, possible psychological, reasons. Thus a long term treatment and rehabilitation program for the narcotics addict has been suggested as being necessary (p. 259, A Goth, Medical Pharmacology, 2nd ed., C. V. Mosby, 1964). In addition, this long term program should allow the addict to otherwise function normally (i.e. attend school, maintain a job) during the ameliorative process. The drug, methadone, is today being utilized to aid in such long term treatment and rehabilitation programs.
A major problem associated with long term methadone therapy is the fact that the drug itself is an addicting narcotic with euphoriant properties; thus one is not curing addiction but merely making it less objectionable.
It is well-known (see for example, pp. 274-278, The Pharmacological Basis of Therapeutics, L. S. Goodman, and A. Gillman, Third ed., 1966, MacMillan), that certain agents (called narcotic antagonists) are able to prevent or abolish some or all of the clinical effects of a dose of a narcotic analgesic such as morphine or heroin in man and animals. Thus, for example, nalorphine prevents or abolishes, in appropriate species, narcotic induced euphoria, analgesia, drowsiness, respiratory depression and other well-known effects and side-effects associated with narcotic analgesic usage. Several narcotic antagonists are in use clinically, for example, to treat narcotic-induced respiratory depression. It is also known that in patients who are physically dependent on narcotic usage small doses of a narcotic antagonist, such as nalorphine, will precipitate acute withdrawal symptoms qualitatively identical to those seen after abrupt withdrawal of the narcotic agent. Thus, administration of the antagonist may be used as a simple, albeit unpleasant, method to test for physical dependence of the suspected narcotics addict.
Many reports in the recent literature (see for example, Agonist and Antagonist Actions of Narcotic Analgesic Drugs, H. W. Kosterlitz, H. O. J. Collier, and J. E. Fillarreal, editors, MacMillan, 1972, and references cited therein) propose the prophylactic use of a narcotic antagonist as an alternate medicinal approach to methadone therapy for the long term treatment and amelioration of narcotics addicts. Thus, it has been observed (M. Fink, A. M. Freedman, R. Resmick, and A. Zaks in Agonist and Antagonist Actions of Narcotic Analgesic Drugs, H. W. Kosterlitz, H. O. J. Collier, and J. E. Villarreal, editors, MacMillan, 1972) that when most previously detoxified narcotics addicts, who are receiving prophylactic therapy with a narcotic antagonist, are challenged with a narcotic agent they do not experience any of the expected clinical effects of the narcotic and their use of narcotic agents, in most cases, is eventually reduced.
In addition to the treatment of problems associated with narcotic analgesic abuse, narcotic analgesic antagonists have been indicated to be useful in the treatment of certain syndromes associated with mental disease or alcoholism, in particular catatonic stupor and hallucinations. See, for example, Emrich, Arzneim.Forsch./Drug Research, 28 (II), Heft 8, 1271 (1978), and Schenk et al., Arzneim.-Forsch./Drug Res., 28, Heft 8, 1274 (1978).